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胸主动脉创伤性夹层的血管内治疗——16例病例系列

Endovascular treatment of traumatic dissection of the thoracic aorta - series of 16 cases.

作者信息

Sarquis Lucas Mansano, Michaelis Wilson, Santos Antonio Lacerda, Pinto Cristiano Silva, Yokoyama Rogerio Akira, Seguro Erick Fernando, Martins Antonio Luiz da Costa, do Vale Vinicius Belas

机构信息

Hospital do Trabalhador - HT, Serviço de Cirurgia Vascular, Curitiba, PR, Brasil.

Hospital Universitário Evangélico Mackenzie - HUEM, Serviço de Cirurgia Vascular, Curitiba, PR, Brasil.

出版信息

J Vasc Bras. 2020 Nov 16;19:e20200074. doi: 10.1590/1677-5449.200074.

DOI:10.1590/1677-5449.200074
PMID:34211523
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8218017/
Abstract

BACKGROUND

Aortic injuries caused by blunt chest traumas have high pre-hospital and emergency mortality. The endovascular approach is one option for treatment of these injuries, but many outcomes related to this approach remain unknown.

OBJECTIVES

The aim of this study is to describe a specialist trauma center's experience with endovascular treatment of cases like these.

METHODS

This is a descriptive study based on review of the electronic medical records of patients who had suffered from blunt thoracic aorta trauma and were seen at a hospital specializing in trauma cases in the city of Curitiba (Paraná, Brazil).

RESULTS

Sixteen patients were included in the study. All patients were traffic accident victims and 75% of the accidents were the result of vehicle collisions. Aortic lesions ranged from grade I to IV and the majority had grade II lesions (50%). All patients underwent endovascular treatment with endografts, an average of 71 hours after the trauma. Two patients died, both from causes unrelated to their aortic injuries. During follow-up, only two patients presented complications (endoleak and progression of the dissection).

CONCLUSIONS

The endovascular method is a viable alternative for treatment of blunt trauma thoracic aortic injuries. Randomized and controlled studies are needed to provide evidence to support indication of this method to treat this type of injury.

摘要

背景

钝性胸部创伤所致主动脉损伤在院前和急诊阶段死亡率很高。血管内治疗方法是治疗此类损伤的一种选择，但许多与此方法相关的结果仍不明确。

目的

本研究旨在描述一家专业创伤中心对这类病例进行血管内治疗的经验。

方法

这是一项描述性研究，基于对在库里蒂巴市（巴拉那州，巴西）一家专门治疗创伤病例的医院就诊的钝性胸主动脉创伤患者电子病历的回顾。

结果

16例患者纳入研究。所有患者均为交通事故受害者，75%的事故是车辆碰撞所致。主动脉损伤范围从I级到IV级，大多数为II级损伤（50%）。所有患者均接受了血管内移植物治疗，创伤后平均71小时进行。2例患者死亡，均死于与主动脉损伤无关的原因。随访期间，仅2例患者出现并发症（内漏和夹层进展）。

结论

血管内治疗方法是治疗钝性创伤性胸主动脉损伤的一种可行替代方案。需要进行随机对照研究以提供证据支持该方法用于治疗此类损伤的适应证。

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本文引用的文献

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Vascular. 2019 Apr;27(2):213-223. doi: 10.1177/1708538119828887. Epub 2019 Feb 10.
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Thoracic endovascular repair (TEVAR) versus open surgery for blunt traumatic thoracic aortic injury.胸主动脉腔内修复术（TEVAR）与开放性手术治疗钝性创伤性胸主动脉损伤的对比
Cochrane Database Syst Rev. 2019 Feb 6;2(2):CD006642. doi: 10.1002/14651858.CD006642.pub3.
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Blunt Thoracic Aortic Injury: Endovascular Repair Is Now the Standard.
钝性胸主动脉损伤：血管内修复现在是标准治疗方法。
J Am Coll Surg. 2019 Apr;228(4):605-610. doi: 10.1016/j.jamcollsurg.2018.12.022. Epub 2019 Jan 8.
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National Trends of Thoracic Endovascular Aortic Repair Versus Open Repair in Blunt Thoracic Aortic Injury.钝性胸主动脉损伤中胸主动脉腔内修复术与开放修复术的全国趋势
Ann Vasc Surg. 2018 Oct;52:72-78. doi: 10.1016/j.avsg.2018.03.045. Epub 2018 Jun 7.
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Long-Term Outcomes of Thoracic Endovascular Aortic Repair Focused on Bird Beak and Oversizing in Blunt Traumatic Thoracic Aortic Injury.钝性创伤性胸主动脉损伤中以鸟嘴和尺寸过大为重点的胸主动脉腔内修复术的长期结果
Ann Vasc Surg. 2018 Jul;50:140-147. doi: 10.1016/j.avsg.2018.02.001. Epub 2018 Feb 15.
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Delayed endovascular aortic repair is associated with reduced in-hospital mortality in patients with blunt thoracic aortic injury.延迟的血管内主动脉修复与钝性胸主动脉损伤患者的住院死亡率降低有关。
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